Adverse events after discharge from the hospital are a major public health concern that deserves much more attention. Two recent studies conducted in the United States and Canada addressed adverse events occurring after discharge from the hospital and found a 19% and 23% incidence rate, respectively, among patients discharged home from the general internal medicine services of major academic/urban hospitals. These rates are five to six times higher than the inhospital adverse event incidence rates. However, there has been no study to examined adverse events in patients discharged home from the general medical service of a community hospital, nor has there been any work to look at the potential differences in adverse event rates between urban and rural patients. Rates for patients discharged back to rural communities could be even higher due to difficulties in access to care and follow-up care. This 24-month prospective cohort study will examine the frequency of adverse events, distinguish preventable from ameliorable adverse events, and determine the timeliness of post-discharge ambulatory appointments (objective 1), and identify the types of adverse events (objective 2) in patients discharged from a community hospital. In addition, the study will examine patient and patient care factors associated with the occurrence of post-discharge adverse events (objective 3). Patients will be identified from the general medical service, run by a hospitalist physician group, of a 770 bed community hospital. Two nurses will recruit patients prior to discharge, contact consenting patients within 3-4 weeks after discharge to conduct a follow-up telephone interview, and review outpatient electronic health records for patients related to patient care received post-discharge. The nurses will combine the information obtained from the telephone interview and the outpatient health record to identify: 1) new or exacerbated symptoms;2) unplanned health services utilization;and 3) abnormal laboratory test results. If nurses identify any of the above information in a patient's interview responses or outpatient health record, they will refer to two physicians who will independently review that patient's entire electronic health record (inpatient/outpatient) and patient responses from the telephone interview to determine the occurrence of adverse events. This project addresses a neglected area of patient safety that is related to AHRQ's mission to improve the quality and safety of underserved communities. This area has been neglected because patient safety research has focused mostly on adverse events in hospitalized patients, with significantly less attention to adverse events following hospital discharge. Results from this study will help community providers develop systemic interventions to improve the hospital discharge process and patient safety during the post-hospital discharge period. Additionally, this study will advance knowledge on post-discharge adverse event predictors, laying the foundation for the development of a screening tool to identify adverse events, throughout the healthcare system, during this vulnerable transition of care from the hospital to home. PUBLIC HEALTH RELEVANCE: Adult Grant Adverse events that occur after discharge from the hospital are a major public health concern that deserves much more attention. Since the emergence of managed care which led to the advent of the hospitalist model of care, there has been a progressive shortening of hospitalizations for patients. The result has been that many things that used to occur in the hospital now occur afterwards, with the accompanying potential for patients to suffer post- discharge adverse events.